Provider First Line Business Practice Location Address:
3867 UNION DEPOSIT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17109-5920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-248-5840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2010